Serious psychological distress and diabetes care among California adults

The impact of social and emotional support on serious psychological distress among people with functional disabilities and type 2 diabetes

OBJECTIVES

To examine the impact of social and emotional support on serious psychological distress (SPD) in individuals with type 2 diabetes (T2DM) and functional disabilities after controlling for socio-demographic factors and health status. Findings provide information for healthcare providers to enhance patients' psychological well-being.

METHODS

Data from 529 adults were obtained from the 2021 National Health Interview Survey, including those who had T2DM and also reported significant difficulty or inability to perform an activity in any of the following domains: seeing, hearing, walking or climbing stairs, communicating, remembering or concentrating, or practicing self-care. Descriptive analysis and a hierarchical regression model of SPD were used.

RESULTS

The mean age of participants was 67.88 years old, and the mean duration of diabetes diagnosis was 16.88 years. Notably, 12.5% of individuals reported SPD. A decreased likelihood of reporting SPD occurrence was associated with older age (odds ratio (OR) = 0.95), a longer duration of T2DM diagnosis (OR = 0.97), having at least a high school education (OR = 0.54), and receiving social and emotional support.

DISCUSSION

Social and emotional support likely mitigates psychological distress, suggesting that social and emotional support resources should be enhanced, especially among individuals who are younger and those more recently diagnosed with T2DM.

Effects of Mental Illness Amongst Adults in the United States Living With Diabetes Mellitus on Hospital Admissions

OBJECTIVE

To examine the influence of comorbid mental illness on hospitalization among adults reporting diabetes mellitus.

METHODS

This cross-sectional observational study used National Health Interview Survey (NHIS) data from 2000-2018 to examine hospitalization. Mental illness was defined as no to low psychological distress (NLPD), moderate psychological distress (MPD), and serious psychological distress (SPD) as per the Kessler-6 scale. Socio-demographic factors and health status were added as covariates in binary logistic regression.

RESULTS

This study involved 48,807 survey participants and reflected an estimated population of 17,524,418 adults with diabetes in the United States, of whom 19.9% were hospitalized in the year prior to the survey. Among those who were hospitalized, 71.5% exhibited None to Low Psychological Distress (NLPD), 17.7% reported Moderate Psychological Distress (MPD), and 10.8% reported Serious Psychological Distress (SPD). Conversely, among non-hospitalized individuals, the percentages were as follows: 83.2% had NLPD, 11.4% had MPD, and 5.3% had SPD. The odds ratio (OR) for hospitalization was found to be OR=1.31 (95% CI: 1.20, 1.43, p<0.0001) for MPD and OR=1.42 (95% CI: 1.28, 1.58, p<0.0001) for SPD, in comparison to those with no or low psychological distress.

CONCLUSION

Among adults with diabetes mellitus, those with mental illness were more likely to be hospitalized than those without mental illness. Programs and policies to improve care among adults with both mental illness and diabetes may help to reduce hospitalizations.

The Association of Cannabis Use and Cigarette Smoking with Psychological Distress Among Adults in California

BACKGROUND

In November 2016, California voters passed the Adult Use of Marijuana Act making recreational cannabis sales legal to adults aged 21and older starting January 1st, 2018. This study aims to understand the relationship of cannabis use and cigarette smoking with serious psychological distress (SPD) in California in light of the legalization of recreational cannabis sales.

METHODS

This cross-sectional study included 42,313 adult participants from the 2017 to 2018 California Health Interview Surveys. We used the Kessler-6 (K6) scale to measure psychological distress in the past 30 days. Multiple logistic regression models were used to examine the association between cannabis/cigarette use and SPD.

RESULTS

Cannabis use was positively associated with SPD (AOR = 2.48, 95% CI = 1.57, 3.91), but this association was not significantly different before and after recreational cannabis sales legalization in California (AOR = 0.82, 95% CI = 0.72, 2.05). Cigarette smoking was also positively associated with SPD (AOR = 2.76, 95% CI = 2.05, 3.71). Compared to those who used neither cannabis nor cigarettes, sole cannabis users (AOR = 2.51, 95% CI = 1.75, 3.60), sole cigarette smokers (AOR = 3.23, 95% CI = 2.28, 4.60), and dual users of cannabis and cigarettes (AOR = 5.65, 95% CI = 4.04, 7.89) were more likely to report SPD. Dual users were also more likely to report SPD than sole cannabis users (AOR = 2.25; 95% CI = 1.48, 3.43) and sole cigarette smokers (AOR = 1.75; 95% CI = 1.18, 2.59).

CONCLUSIONS

These findings provide evidence for the need to develop effective cessation intervention strategies targeting individuals with SPD to reduce their cannabis use and dual-use of cannabis and cigarettes.

Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review

Background

Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.

Methods

PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.

Results

Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.

Conclusion

Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.

Real-Time Data Collection to Examine Relations Between Physical Activity and Affect in Adults With Mental Illness

Adults with serious mental illness engage in limited physical activity, which contributes to significant health disparities. This study explored the use of both ecological momentary assessments (EMAs) and activity trackers in adults with serious mental illness to examine the bidirectional relationship between activity and affect with multilevel modeling. Affective states were assessed up to seven times per day using EMA across 4 days. The participants (n = 20) were equipped with a waist-worn accelerometer to measure moderate to vigorous physical activity. The participants had a mean EMA compliance rate of 88.3%, and over 90% of completed EMAs were matched with 30-min windows of accelerometer wear. The participants who reported more positive affect than others had a higher probability of engaging in moderate to vigorous physical activity. Engaging in more moderate to vigorous physical activity than one's usual was associated with more negative affect. This study begins to address the effect of momentary mood on physical activity in a population of adults that is typically difficult to reach.

Association between sleep and serious psychological distress in patients with diabetes

Diabetes is the 7^th leading cause of death in the U.S. and impacts patients' physical health and also increases the risk for psychological distress. Sleep disturbance is a common complaint in patients with diabetes and likely impacts psychological well-being. This study examined the relationship between sleep characteristics and serious psychological distress (SPD) in people with diabetes by conducting a secondary analysis of cross-sectional data from the 2015 National Health Interview Survey (N= 3474). Approximately 7% of the participants reported SPD and 27% reported sleep durations that were shorter or longer than the recommended 6-8 hours daily. Hierarchical logistic regression analysis showed that people who reported daily sleep of 1-5 hours or 9 or more hours were more likely to report SPD than individuals who slept 6-8 hours a day. Respondents who reported a higher frequency of taking medication for sleep and having trouble staying asleep were also substantially more likely to have SPD. However, an increase in the number of days feeling rested when waking up was a protective factor that decreased the risk of SPD. The findings suggest that both sleep disturbances and SPD, because of their high prevalence, should be included in the routine evaluation for diabetes care.

Mental health status and dietary intake among California adults: a population-based survey

California Health Interview Survey (2005-2015) data were used to examine the association between dietary intake frequencies and mental health - Kessler-6 scores categorised as no/low (NLPD), moderate (MPD) or serious psychological distress (SPD). The 245,891 surveys represented 27.7 million adults annually, with 13.2% having MPD and 3.7% SPD. Survey-adjusted regression adjusting for gender, age, race, education, poverty, marital status, BMI, geography and year found MPD and SPD associated with lower consumption of fruits (adjusted odds ratio 0.79 and 0.65, respectively), vegetables (AOR 0.81 and 0.68), and increased consumption of French fries (AOR 1.24, 1.30), fast food (AOR 1.32, 1.27), soda (AOR 1.23, 1.26) and variance-adjusted daily teaspoons of sugar (coefficients 3.05, 4.21), all p-values less than 0.001. In this large population-based sample, moderate and SPD were independently associated with unhealthy diet. Targeted public health interventions could focus on young adults and those with less than 12 years of education.

Serious psychological distress and diabetes: a review of the literature

With the development of a measure of serious psychological distress (SPD) in 2002, more attention is being paid to the association of SPD with diabetes outcomes and processes of care. We review the literature on the relationship between SPD and diabetes processes of care and outcomes, as well as the literature on the relationship between specific mental health diagnoses and diabetes processes of care and outcomes during the 2010 to 2011 period. There is an extensive literature on the association of mental health diagnoses with diabetes outcomes, especially for depression. Because the Kessler scale measures a much broader range of mental health issues than any specific DSM-IV/Structured Clinical Interview for DSM Disorders diagnosis and is designed to assess SPD at the population level, additional research needs to be conducted both in clinical settings and using large administrative datasets to examine the association between SPD and diabetes outcomes and processes of care.